The public health policy advocate: fostering the health of communities

The community health clinical nurse specialist (CNS) is unique among CNSs in defining the client as a community of people. This nurse specialist operates in partnership with the community using policy development and policy advocacy in nursing interventions. These nursing interventions enable and empower communities to explore pathways to public policy change. Such changes include improving accessibility, availability, and affordability of health services, and changing social conditions found at the root of many health problems. A case study is presented to illustrate the application of this CNS role.     

A competency-based orientation program for the clinical nurse specialist

A factor affecting role development of the clinical nurse specialist (CNS) is the orientation process. Unless nursing service provides the structure for enhancing role development, frustration, nonacceptance, and even early termination of a qualified clinical nurse specialist may result. An orientation program provides the mechanism to guide the CNS through the introduction phase of the CNS role in the institution. Without such a program, the CNS may not acquire the fundamental understanding of the nursing department's service and educational philosophy.     

The role of the clinical nurse specialist in medical-surgical nursing.

A clinical nurse specialist (CNS) is an expert nurse clinician who focuses on improving nursing care. The CNS role is the subject of a great deal of debate and confusion, but clinical nurse specialists make a valuable contribution to the health care team.     

The role of the clinical nurse specialist: problems and solutions

The clinical nurse specialist (CNS) is a generally untapped resource for the nurse executive. Although seen as an asset, the CNS may be considered an expensive and nonessential part of the department of nursing. The role is threatened with extinction not only because it is seen as dispensable in a time of cost restraint, but also because of problems in role implementation. We believe the CNS role is vital to the advancement of nursing practice and that the impact of the CNS on nursing practice has not reached its full potential. This paper summarizes the major problems inhibiting role development in the hospital setting and suggests solutions to the nurse executive for maximizing the role potential of the CNS.     

A modern African perspective on the role of the clinical nurse specialist

In Africa, there is an overwhelming and increasing prevalence of illnesses such as HIV and AIDS, tuberculosis, and malaria. This constitutes a "burden of disease" facing Africa. Nursing must evolve accordingly to the changing needs of clients, many of whom have chronic illnesses. In achieving desirable outcomes, it is essential to adopt and adapt the clinical nurse specialist (CNS) role so that expert and specialist practice is available to clients in a cost-effective manner. The role of the CNS singles out clinical responsibilities in a hospital setting so that nurse administrators can concentrate on the provision of resources. A CNS position in the hospital structure would offer a clinical career pathway for advanced practice nurses who wish to remain "by-the-bedside." Regional initiatives are already beginning to show a need for master's-prepared, advanced practice nurses in the clinical areas so as to reduce maternal mortality.     

Perspectives on developing, marketing, and implementing a new clinical specialist position

The purpose of this article is to provide guidelines for the clinical nurse specialist (CNS) who is involved in setting up a new position. The article describes the use of marketing strategies as a means of introducing the role to a prospective employer. Three guidelines are proposed as a framework for successful development of a new position. They are: (1) clearly defined purposes, goals, and role responsibilities, (2) mutual agreement of role expectations, and (3) self-confidence of clinical knowledge and ability. The article discusses the issues of unrealistic expectations, credibility, and role competition as potential difficulties in implementing a new position and offers suggestions to assist the CNS to realize success in implementing a new position. The key to success in setting up a new position is to develop the function that makes the CNS most valuable to the employer.     

Practical strategies for CNS role implementation

Methods of implementing the clinical nurse specialist (CNS) role can be approached in many ways. Providing the clinical specialist with concrete strategies to use during role implementation or expansion can aid in expediting the acceptance process for the CNS. Some authors have discussed phases the CNS encounters during role development. Time span of these phases vary greatly, dependent not only on the individual specialist, but also on the system for which they are employed. Kramer's four phases detailing the adjustment period of the newly practicing nurse may be used when discussing CNS role implementation. These four phases are: honeymoon, shock/rejection, recovery, and resolution. Practical suggestions to expedite role implementation can make progression through these phases easier and less overwhelming. Although obstacles will often be present, the CNS must then become a catalyst by using creative ideas and effective coping mechanisms to effect change and advance the role.     

Leadership and the Clinical Nurse Specialist: From Traditional to Contemporary

The role of the clinical nurse specialist (CNS) is multidimensional. Although clinical expertise is the central core of the CNS role, the aspect of leadership is pivotal to effecting change in practice. Recently, the National Association of Clinical Nurse Specialists has redefined the role by spheres of influence and core competencies. Still, clinical expertise is central. This article highlights challenges as well as rewards in the CNS role. In addition, an example of entrepreneurial endeavors for the CNS is presented.     

Clinical nurse specialist: role restructuring to advanced practice registered nurse

This article recognizes challenges facing the traditional clinical nurse specialist (CNS) role and supports the merger of the nurse practitioner (NP) and the CNS into a hybrid advanced practice registered nurse (APRN). A historical review of each role is presented, with justification for role merger. The focus of the article is to present a personal account of this author's successful reengineering of a traditional cardiovascular CNS role to conform to a new state and institutional APRN model and ultimately to better serve a population of post-myocardial infarction patients.     

The role of the urology clinical nurse specialist in the multidisciplinary team meeting

Multidisciplinary teams (MDTs) are increasingly the preferred method of cancer care in many specialties, including urology. MDTs provide a means of improving communication between health care professionals and patients and provide co‐ordinated and timely care. As MDTs have developed, so too has the role of the specialist cancer nurse, though the concept of the clinical nurse specialist (CNS), or their involvement in the MDT are not globally universal. There is increasing evidence that the presence of the CNS in the MDT improves patient satisfaction and team effectiveness. The MDT meeting is the focal point for decision‐making about patients' care, but the roles of health care professionals in the MDT meeting are variable and poorly defined. In this paper, we examine the evidence for the role of the CNS in the urology MDT meeting, which includes communicating with colleagues and patients, co‐ordinating care, as well as facilitating research and clinical governance. We discuss the challenges faced by CNSs and how their role in MDT meetings can be strengthened to enhance their effectiveness in the MDT in general.     

The clinical nurse specialist--a personal perspective.

The post of clinical nurse specialist (CNS) is relatively new in the United Kingdom, and research so far suggests that the intensive care unit is an appropriate area for the further development of the role (Thompson et al, 1986). The purpose of this paper is to examine the function of a clinical nurse specialist within an intensive care unit, and to discuss the various aspects that constitute the role, within the fields of clinical practice, education, research and management. Nursing practice is developing--the aim being truly individualised patient care. A clinical nurse specialist should be in an ideal position to innovate, lead and evaluate change.     

The clinical nurse specialist in the faculty role

Often, contributions by the clinical nurse specialist (CNS) are seen as exclusive to CNSs employed in the service setting. Yet, this may be too narrow a view of the possibilities of the specialist role. This paper examines how a faculty member in a school of nursing who does not hold a joint appointment can fulfill the mission and intent of the CNS role. Citations from the literature and examples from practice describe how the CNS who is a faculty member can enhance nursing as a direct care provider, consultant, researcher and educator.     

The role of the clinical nurse specialist in information systems selection

As computer utilization in the health care industry continues to expand, the role of the nurse in the system selection process increasingly becomes paramount. Information systems are more likely to have a nursing perspective if the nurse who is involved in the information system selection process is a clinical nurse specialist (CNS). Three principles of practice which should be utilized in structuring the role of the CNS in the information system selection process are discussed, along with practical guidelines to assist the CNS in participating effectively.     

Precepting the clinical nurse specialist student

The education role of the clinical nurse specialist (CNS) includes precepting the CNS graduate student. If the novice CNS is left to flounder, preceptorship can be a frustrating experience. This article describes a model for precepting CNS graduate students. Such a model provides a guideline and a sense of direction for the CNS. To clarify further the role of the CNS as a preceptor, the article offers practical learning experiences for the implementation of the model.     

The clinical nurse specialist and nurse practitioner roles: room for both or take your pick?

OBJECTIVE: The aim of this paper is to contribute to pertinent discussions regarding advanced practice nursing roles. In particular discussion will focus on the potential implications for the developing nurse ractitioner (NP) role on the existing clinical nurse specialist (CNS) roles. SETTING: The literature presented originates primarily from the United States of America (USA), United Kingdom and Australia. Specific emphasis is placed on the psychiatric/mental health nursing context. PRIMARY ARGUMENT: Amidst the confusion in terminology to describe and explain advanced, expanded or extended nursing roles, and to distinguish between the clinical nurse specialist and the nurse practitioner, there is a need to establish clarity. The need for both clinical nurse specialist and nurse practitioner roles has been hotly debated in the USA. CONCLUSIONS: The roles of clinical nurse specialist and nurse practitioner may be complementary but fulfil different functions. It is therefore important that both roles be maintained and implemented in response to consumer and health service needs.     

The evolving role of the community nurse specialist in palliative care

The community clinical nurse specialist in palliative care role has evolved in an uncoordinated manner resulting in a variety of grades of nurse with differing role expectations. In general the CNS role consists of a clinical, educational, strategic and managerial remit. The reality of working with such a diverse role creates tension and conflict for the CNS between personal, organization and practical expectations. Despite this the community palliative care CNS is central to the future development of palliative care services in the community generating a culture of sharing knowledge and expertise. This will however require further investigation into the impact these demands will have on the individual.     

Articulating the role of the clinical nurse specialist in new brunswick

The clinical nurse specialist (CNS) role is often misunderstood and underutilized. Through partnership with the CNS Advisory Committee in the Horizon Health Network and the Masters of Nursing Program at the University of New Brunswick, the authors developed a clear articulation and visual representation of the CNS role in New Brunswick. This paper synthesizes information gleaned from interviews with the clinical nurse specialists working within Horizon Health Network and integrates this information with the published literature and the position statement of the Canadian Nurses Association (CNA). Vision, voice and value emerged as key considerations, as did barriers to, and successes of, the CNS role. This paper contributes to the acquisition of knowledge regarding the role of the CNS according to the CNA and current published literature. It further promotes an understanding of the important role of the CNS in the healthcare system in New Brunswick, and introduces strategies that can be utilized by clinical nurse specialists to demonstrate value and support the continuation of the role.     

Role development of the clinical nurse specialist within the Indian Health Service

The clinical nurse specialist is employed in many health care facilities to improve patient care. One service unit of the Indian Health Service has expressed interest in the development of this role. At the present time, there are no advanced practitioners within this facility. Development, as well as implementation of the role, must be based on the cultural and health care needs of the Indian people. This paper discusses development of the role of perioperative clinical nurse specialist, based on personal experience, at a service unit providing health care to a large tribe of American Indians in the Southwestern United States. Examples of care incorporating cultural practices, are used to illustrate the practice of the perioperative specialist within the Indian Health Service. The nursing process is used to organize the development of the role.     

专科护士核心能力架构之探讨

结合在澳门举行的＂第二届专科护理实践国际研讨会＂主题演讲内容,总结及讨论世界范围具有代表性国家或地区的专科护士能力架构及其意义和用途。不同国家或地区所提出的专科护士核心能力中,共同的核心组成部分有4个方面：①直接提供临床护理的能力;②领导与决策能力;③教育与指导能力;④科研能力。核心能力作为一个架构,主要用于指导本国家或地区专科护士培训课程设置以及发展专科护士临床实务能力评价指标等用途。     

Roles of the liver transplant clinical nurse specialist

The liver transplant clinical nurse specialist (CNS) is an emerging position in the quickly growing and changing liver transplant field. The role of the liver transplant CNS varies in different phases of the patient's extended care. This article discusses the expert practitioner, consultant, educator, and researcher roles as well as the collaborator skill.